Botox, Dysport, and Xeomin: Which Is Best?

Posted by Dan Powell on October 24th, 2018

Battle of the Best Injectables for Facial Wrinkles

You have facial wrinkles and want to get rid of them. The most well-known injectable method is obviously Botox.

However, Botox isn’t the only botulinum toxin-based injectable that removes wrinkles. Dysport and Xeomin do as well.

But, which one works best? When it comes to removing wrinkles, it’s becoming a battle of the best injectables.

First, it’s important to understand what a botulinum toxin-based injectable, like Botox, is. Botulinum toxin is a purified, controlled dose protein derived from the bacterium Clostridium botulinum, but it does not actually contain any live bacteria. When a small dose is injected into the muscles under a wrinkle, the muscles responsible for that wrinkle become temporarily paralyzed for around four months. During this time, the muscles are no longer able to contract, and thus the wrinkle diminishes.

Injecting botulinum toxin is a non-invasive procedure that has been used for decades. According to Dr. Andrew Hayduke M.D., an American Society of Plastic Surgeon's board certified plastic surgeon and former Chief of Plastic Surgery at Eisenhower Medical Center, Botox/Dysport/Xeomin all work best on dynamic wrinkles. Dr. Hayduke explains, “Dynamic wrinkles are wrinkles that form when you actively move your facial muscles, such as when you smile or frown.” The most prominent examples of dynamic wrinkles are frown lines that form between your eyebrows when you frown downwards and crow’s feat that deepen when you smile. Dr. Hayduke explains, "Static wrinkles, on the other hand, are well established wrinkles that are present even without any facial expression or movement - botulinum toxin of any type will not work on these static wrinkles, since these wrinkles exist without any muscle movement whatsoever." Dr. Hayduke recommends other cosmetic techniques for stubborn static wrinkles, such as laser treatments, chemical peels or even various surgical lifts.

Botox, Dysport, and Xeomin are all made from the same botulin toxin, but have a slightly altered chemical formula. Botox was FDA-approved in 1989, Dysport in 2009 and Xeomin in 2011.

One of their differences is the way they need to be administered. Each product diffuses slightly differently, so the injection points need to be altered for the best result. This occurs because both Botox and Dysport have protective carrier proteins, while Xeomin is a purified version where the protective proteins have been removed. Without these proteins, Xeomin weighs less and diffuses slightly differently. It also does not need to be refrigerated.

"The skill of the injector is paramount when it comes to injecting different forms of botulinum toxin, since the technique used needs to account for the diffusion properties of the injectable agent. In my personal practice, I do not delegate injections to a nurse or other mid-level practitioner. I insist on doing all the botulinum toxin injections myself, and my clients definitely appreciate that fact.", explains Dr. Hayduke.

Another small difference between the three products is the amount of time for the injection to become effective. It takes Botox and Xeomin an average of three to five days, while Dysport takes only one to three days. These differences are of minimal significance.

Most studies suggest that Dysport and Xeomin work similar to Botox. For some, Dysport and Xeomin might work better, but the main problem is the lack of experience using these two drugs.

People know the trade name "Botox", trust it, and ask for it by name. There have been thousands more peer-reviewed papers on Botox than on Dysport and Xeomin. Doctors are used to it, and the success rate of Botox is well documented. It isn’t that Botox is inherently better, but because doctors are used to it, and patients know what to expect, it is simply used much more frequently even in the most modern cutting edge plastic surgery practices.

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Special thanks to Dr. Andrew J. Hayduke, M.D. Dr. Hayduke has been listed on several "Best Plastic Surgeon" and "Top Plastic Surgeon" listings, both in Palm Springs California and Beverly Hills California. He has served as former Chief of Plastic Surgery at a well-respected southern California hospital and is board certified in plastic surgery. His website is https://www.drhayduke.com